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Equity in COVID-19 Vaccines: Emerging Lessons from the Front Lines

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Equity in COVID-19 Vaccines: Emerging Lessons from the Front Lines FAMILIESUSA.ORG Equity in COVID-19 Vaccines: Emerging Lessons from the Front Lines As of March 2021, the United States is administering more than 3 million COVID-19 vaccines a day.1 From the day vaccines were on the horizon, Congress,2 governors,3 and the Biden administration4 committed to equitably distributing them, pointing to disproportionately high rates of COVID-19-related illness and death among Black, Indigenous, and people of color (BIPOC). These disparate outcomes from COVID-19 are linked to longstanding inequities in health care and systemic racism within society.5 Accomplishing equitable distribution, however, It is essential for policy makers and the public to generally has not been achieved.6 In ramping up understand that BIPOC are bearing the brunt of this vaccine distribution quickly, state leaders report trying pandemic, both in terms of their health and their financial to balance low supply and high demand while also wellbeing. Since the pandemic began, BIPOC have been navigating competing demands for prioritization. One disproportionately more likely to become infected, to be concerning choice was the conscious decision by some hospitalized, and to die compared to their percentage of state leaders to move toward strategies based on age the population.11 For example, data from Rhode Island (as Connecticut and Maine did)7 and away from equity- indicate that Black and Latino individuals ages 35-44 based strategies that focus on essential workers,8 who are three times more likely to be hospitalized from are disproportionately more likely to be BIPOC.9 And than older White individuals ages 74-85 (see page 2). even as supplies have increased, the pattern across And now, they are not being given access to vaccinations virtually every states is consistent: Black and Hispanic in ways that are proportionate to either their share of the people continue to get fewer vaccine shares relative to population or their risk of illness and death. Moreover, the the COVID-19 death and illness they experience.10 April 2021 Issue Brief FAMILIESUSA.ORG Rhode Island Department of Health Source: Rhode Island Department of Health (RIDH), Age-adjusted rates of COVID-19 hospitalizations by age group & race/ethnicity. Sources: RIDOH, Hospital Incident Reporting System data; RIDOH, SalesForce COVID-19 case investigation data; US Census Bureau, 2018 American Community Survey 5-year estimates; CDC age adjustment weights pandemic is not just a health, but also an economic crisis be at the center of today’s response and future efforts to for BIPOC. Because these communities are more likely build resilience, prepare for the next public health crisis, to have front-line jobs (placing them at much higher risk and create a more equitable health system overall. of increased exposure), they are less likely to be able to To this end, Families USA has developed a roadmap work from home. As a result, their jobs often force them of promising approaches for equitable distribution to choose between prioritizing their economic livelihood of vaccines in the short term, based on input from and their health.12 Thus, a vaccination strategy that is state and local partners. The roadmap synthesizes fundamentally aimed at reducing death and illness early lessons and provides key insights and concrete from COVID-19 must intentionally focus on effective approaches that state partners and leaders can use vaccination of BIPOC populations. moving forward. We are at a critical moment for ensuring health care This roadmap is the first in a series of publications equity and correcting the fundamental disparities that and other work that Families USA will undertake the pandemic has laid bare. Intentional investments in with partner organizations to ensure the equitable equitable distribution of the vaccines — and equitable distribution of COVID-19 vaccines. Further research, public health strategies designed to end the pandemic including roundtables, focus groups, and support of — have the potential to establish a course-correction a consumer advocate learning network, is underway. on which we can build long-lasting structural change. Please connect with us at Familiesusa.org for updates Focusing on the experiences and needs of BIPOC must on this work. 2 FAMILIESUSA.ORG Roadmap for the Equitable Distribution of COVID-19 Vaccines Overarching Principle: A vaccination strategy that aims to reduce death and illness from COVID-19 must intentionally focus on effective vaccination of communities of color. USE A DATA-DRIVEN APPROACH » COVID 19 Community Vulnerability Index (CCVI)16 To develop policies for allocating vaccines in » CDC’s Social Vulnerability Index (SVI)17 an equitable manner, gather data to determine 18 who is most likely to contract COVID-19 and to » Area Deprivation Index (ADI) experience negative consequences such as death » Map: County-Level Access for Black and White and hospitalization. National, state, and local Individuals to Potential COVID-19 Vaccine 13, 14 dashboards that track cases, hospitalizations, Administration Facilities,†, 19 and vaccine allocation disaggregated by race, ethnicity, and other demographics are an important Importantly, while these indices are a helpful foundation for this type of data. However, there has barometer for a data-driven approach, they are been inconsistent and incomplete data and reporting incomplete and require local input to increase on race and ethnicity at the local, state and national success. For example, the Social Vulnerability Index levels on testing, cases, hospitalizations, deaths and (SVI), like the U.S. Census, leaves out Middle Eastern 20 now vaccines.15 To get more granular, states and and North African populations, and even when data localities are employing other assessment tools to does take into account race and ethnicity, there is still inform equitable approaches and ascertaining which heterogeneity within communities that is important to 21 communities might need additional resources and understand. In order to effectively tailor responses support to maximize vaccine uptake. Governmental to specific communities, state leaders need to officials and public health experts should consider supplement assessment tools with qualitative data via the following examples as part of an equitable direct input from key community stakeholders. vaccine distribution strategy: Spotlight on Protect Chicago Plus Protect Chicago Plus, an initiative of Mayor Lightfoot, used SVI data to prioritize 15 high- need communities “to ensure that a significant part of the City’s vaccine supply goes to these communities.” † Geomapping such as this example from the University of Pittsburgh School of Pharmacy and West Health can help state leaders understand where vaccination sites should be located and how far individuals have to travel to access services. 3 FAMILIESUSA.ORG CONNECT WITH THE COMMUNITY AND PROVIDE RESOURCES Spotlight on Community-Based Vaccinations: A Tale of Three Communities When things are moving quickly — as they are In Fort Worth, TX in the world of COVID-19 vaccine distribution — understanding the local context is key. In particular, some community leaders are organizing to distribute Community A: Hispanic Population the vaccines and engage their neighbors to increase » Community groups worked with an engaged uptake while simultaneously providing contours to and enthusiastic councilmember who a successful public health approach in their own helped to drive the vaccine event including community. Locally-organized efforts led by trusted using social media channels. pillars of the community can be essential to success. Community members were able to get their State and local public health partners should identify, » vaccines and talk with the councilmember learn from them, address barriers and provide them about other issues in their community. resources to execute vaccination initiatives. » Event was held at the local community When figuring out how to scale vaccine efforts center. state leaders can identify and encourage effective 335 people were vaccinated. approaches by hosting community listening sessions » and by emulating successful case studies from within their own state and around the country. One example Community B: Hispanic and Black Population from Philadelphia highlights the local partnerships between medical centers and African American » Community groups were not engaged in the churches that helped vaccinate 5,000 Black residents vaccine clinic. in one day.22 Another example from Fort Worth, Texas, » No local officials attended, and turnout was provides a “tale of three communities,” (see sidebar) low. highlighting the importance of having a local champion with authority and community reach, authentic » Event was held at a local fire station. engagement and connecting in trusted spaces.23 » 39 people were vaccinated. A few key elements that lead to success include: Community C: Black Population » Ensuring that community leaders participate routinely in advising city and state officials » Event led by a local church congregation. about allocation strategies and events. One » Church leaders attended and promoted the way this can be accomplished is by working with event heavily. community leaders to host listening sessions that are open to the entire community. These » Event was held at the church. sessions should also include local leaders, trusted » 757 people were vaccinated. 4 FAMILIESUSA.ORG health care professionals, and other influential managing expectations of non-community stakeholders
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